1 PHASE III, PART III COURSE CONTENT OBSTETRICS AND GYNAECOLOGY a) Goal The broad goal of the teaching of undergraduate students in Obstetrics and Gynaecolo is that he/she shall acquire understanding of anatomy, physiology and pathophysiology the reproductive system and gain the ability to optimally manage common conditions affecting it. b) Objectives Knowledge At the end of the course, the student shall be able to: 1. outline the anatomy, physiology and pathophysiology of the reproductive system and the common conditions affecting it; 2. detect normal pregnancy, labour puerperium and manage the problems he/she is likely to encounter therein; 3. list the leading causes of maternal and perinatal morbidity and mortality; 4. understand the principles of contraception and various techniques employed, methods of medical termination of pregnancy, sterilisation and their complications; 5. identify the use, abuse and side effects of drugs in pregnancy, pre menopausal and post menopausal periods; 6. describe the national programme of maternal and child health and family welfare and their implementation at various levels; 7. identify common gynaecological diseases and describe principles of their management 8. slate the indications, techniques and complications of surgeries like Caesarean section laprotomy, abdominal and vaginal hysterectomy, Fothergill s operation and vacuum aspiration for Medical Termination of 1regnancy (MTP).
2 Skills At the end of the course, the student shall be able to: 1. examine a pregnant women, recognise high risk pregnancies and make appropriate: - referrals; 2. conduct a normal delivery, recognise complications and provide postnatal care: 3. resuscitate new born and recognise congenital anomalies; 4. advise a couple on the use of various available contraceptive devices and assist in insertion and removal of intra-uterine contraceptive devices 5. perform pelvic examination, diagnose and manage common gynaecological problems including early detection of genital malignancies; 6. make a vaginal cytological smear; perform a post coital test and wet vaginal smear examination for,trichomonas,vaginalis,monilia,gram sstainfor Gonorrhoea; Gynaecology 7. Interpret data of investigations like biochemical, histopathological radiological, - physiology of ultrasound etc. Integration The student shall be able to integrate clinical skills with other disciplines and bring about coordination of family welfare programme for the national goal of population control. Departmental Objectives At the end of training in Obstetrics and Gynaccology, MBBS student will be able to: Knowledge 1. Appreciate the socio-cultural, economic and demographic factors that influence the practice of Obstetrics and Gynaecology. 2. Appreciate the principles of reproductive anatomy and physiology. 3. Understand the preconception, antenatal, intranatal and postnatal factors including drugs ed, methods that affect the mother and foetus. 4. Recognise the changes and adapation that occur in the mother during pregnancy. labor and a and post partum. 5. Impart antenatal care, detect deviations from normal pregnancy and refer risk cases ire and their appropriately. 6. Manage normal labor, recognise the factors that may lead to complications and refer such mrnagement; cases appropriately. 7. Institute primary treatment in Obstetrics and Gynaecology emergencies.
3 8. Resuscitate and take adequate care of the new born. 9. Assist couples with infertility and those requiring contraception. 10. Know the aetio-pathology and management of menstrual abnormalities. 11. Know about the benign and malignant tumors of the genital tract and appreciate the need for screening and prevention. 12. Recognise the importance of infection and other diseases of the genital tract know about appropriate the displacements of genital tract and injuries 13. Understand the implications of mediocolegal and ethical issues concerning the speciality. 14. Acquire communication, decision making and managerial skills. General guidelines for training 1. Students shall attend of a maternity hospital or maternity wards of a general hospital including (i) antenatal care, (ii) the management of puerpedum, and (iii) a minimum period of 5 months in the inpatient and outpatient sections including family welfare planning. 2. Of this period of clinical instruction, not less than one month shall be spent as a resident pupil in the labor room of a maternity ward or a general hospital. During this period. the student shall conduct at least 10 cases of under adequate supervision and assist in 10 other cases. 3. A certificate showing the number of cases of attended by the student in the maternity hospital and /or patient homes respectively, shall be signed by a responsible medical officer on the staff of the hospital and shall state; a. that the student has been present during the course of and personally conducted each case, making the necessary abdominal and other examinations under the supervision of the certi1 ing officer who shall describe his official position b. that satisfactory written histories of the cases conducted including wherever possible antenatal and postnatal observations, were presented by the student and initiated by the supervising officer. c) Course Contents 4th TERM OBSTETRICS BROADER PERSPECTIVES 2 hours 1. Vital statistics, birth rate, maternal mortality, perinatal and neonatal mortality, live birth, still birth, abortion, period of viability including definition of all above
4 ANATOMY OF THE FEMALE REPRODUCTIVE TRACT 1. Basic Anatomy: 3 hours Relationship to other pelvic organs. Applied anatomy as related to Obstetrics and Gynaccological surgery PHYSIOLOGY OF CONCEPTION 1. Ovulation, menstruation, fertilisation and implantation 2. Gametogenesis. 2 hours DEVELOPMENT OF FOETUS AND PLACENTA 3 hours 1. Basic embryology, factors influencing foetal growth and development, anatomy of placenta 2. Teratogenesis, placental barrier DIAGNOSIS OF PREGNANACY 2 hours 1. Clinical features, differential diagnosis, principles underlying the pregnancy tests 2. Immunological tests and their interpretation, ultrasonogram MATERNAL CHANGES IN PREGNANCY 1. Genital tract, cardiovascular system and Haematology 2. Respitatory and gastrointestinal system. 2 hours ANTENATAL CARE 6 hours 1. Objectives of antenatal care: assessment of period of gestation, detection of abnormality with the help of gravidogram; clinical monitoring of maternal and foetal well-being; detection of normal foetal pelvic relation (obstetrical palpation); advise regarding nutrition; prescribing in pregnancy; immunisation against tetanus; basic investigations. 2. Foetal well-being: biophysical monitoring: pelvic assessment.
5 6 th TERM GYNAECOLOGY I. PHYSIOLOGICAL VAGINAL DISCHARGE 1 hour I. Clinical characteristics: Biology of vagina, cytology of vagina, natural defence mechanisms against infections, bacterial flora of vagina. II. PATHOLOGICAL VAGINAL DISCHARGE 2 hours 1. Aetiology, characteristics: clinical recognition; investigation, treatment of common causes: genital hygiene. III. ABNORMAL AND EXCESSIVE MENSTRUAL BLEEDING 1 hour IV. AMENORRHOEA 2 hours 1. Primary and Secondary amenorrhoea: Causes, principles of management V. V. DYSFUNCTIONAL UTERINE BLEEDING 1 hour 1. Aetipathology, classification; clinical aspects and diagnosis, principles of investigation and management 2. Hormone therapy, management options VI. FERTILITY AND INFERTILITY 2 hours 1. Causes in male and female; Physical examination of both female and male partners; essential investigations and interpretation 2. Management options; principles of Medically Assisted Reproductive Technology (MART) VII. ENDOMETRIOSES AND ALLIED STATES 1 hour 1. Aetiopathology; clinical features; principles of investigation and management
6 2. Implications in health and fertility VIII. ENDOMETRIOSES AND ALLIED STATES 1 hour 1. Injuries of female genital tract; Causes; prevention; clinical features; principles of management 2. Diseases of Urinary system 2 hours IX. GENITAL INFECTIONS INCLUDING STD, AIDS AND PELVIC TUBERCULOSIS, INFECTIONS AFFECTING INDIVIDUAL ORGANS 1. Aetiology, pathology, clinical features, differential diagnosis, principles of basic investigation and medical therapy 1 hour 2. STD in the female 2 hours Tuberculosis of female genital tract 3. Long term implications; surgical management. X. DISPLACEMENTS OF UTERUS, GENITAL PROLAPSE 2 hours 1. Aetiology, clinical features; diagnosis principles of management; preventive aspects. XI. BENIGN TUMOURS OF PELVIC ORGANS CERVICAL, 2 hours UTERINE, OVARIAN 1. Aetiology, clinical features; diagnosis, principles of management; preventive aspects XII. TUMOURS OF PELVIC ORGANS CENTRAL, UTERINE, OVARIAN 1. Aetiopathology, clinical features; differential diagnosis; principles of management. 7th TERM I. ABNORMAL OBSTERTRICS
7 Complications of early pregnancy 1. Abortions: definition, types, causes 1 hour Management of incomplete, inevitable abortion 1 hour 2. Recurrent abortions 1 hour 3. Induced abortion. 2 hours Aetiopathology, impact on maternal and foetal health, principals of management 4. Ectopic pregnancy: Causes, clinical features, differential diagnosis 2 hours of acute abdomen, and conservative management of ectopic pregnancy and Principles of surgical management. 5. Trophoblastic diseases : Aetiopathology, clinical, features, differential 2 hours diagnosis,principles of management, follow up. 6. atory investigations and ultrasonograpy in lst trimester of pregnancy. 1 hours 7. Hyperemesis gravidarum: Definition, aetiology, clinical features and management. 8. Pregnancy induced hypertension: 2 hours 2 hours a. Definition: early detection; investigations: principles and management of pregnancy induced hypertension and eclampsia b. Aetiopathology, differential diagnosis of convulsions in pregnancy, complications of eclampsia. 9. Anemia in pregnancy: 2 hours Aetiology, classification, diagnosis, investigations, adverse effects in the mother and labor, management. 10. Other medical disorders like heart disease/diabetes mellitus and 3 hours urinary tract infection a) Clinical features; early detection; effect of pregnancy on the disease and impact of the disease on pregnancy. b) Complications of the diseases. 11. Gynaecological Disorders in Pregnancy:Fibroid in Pregnancy, ovarian tumour, Retroverted gravid uterus, Genital prolapse and pregnancy, Cancer cervix with pregnancy. 2 hours
8 II. NORMAL LABOR Physiology, mechanism in occipito anterior presentation, monitoring, partograrn; conduct of labor; pain relief. III NORMAL PUERPERIUM 8 th Term OBSTETRICS 1. a) Antepartum haemorrhage, Classification, aetiopathology, 3 hours b) Accidental haemorrhage, clinical features, differential diagnosis, c) Placenta previa: } Ultra- sonography,complications and management 2. Abnormal presentations, cord prolapse and contracted pelvis:causes, 6 hours salient features, principles of management of occipito posterior, face and brow presentation, breech delivery.obstructed labor: definition, clinical features, prevention, management 3. Multiple Pregnancies: causes, clinical features, investigations, diagnosis 1 hour and complications, principles of management. 4. Induction of Labor 1 hour 5. Pre-term labor, P.R.O.M. Post maturity, Intra -uterine death 1 hour 6. Complications of third stage of labor:complications; predisposing 2 hours factors, prevention; management of atonic PPH and management of injuries to the lower genital tract. 7. Uterine dysfunction: classification; recognition of uterine dysfunction; 2 hours principles of induction and acceleration of labor 8. Foetal distress and foetal death: Clinical features; causes: 2 hours diagnosis; principles of management prevention 9. Neonatal problems and resuscitation
9 10. Haemolytic diseases including Rh isoimmunisation mechanism; 2 hours prophylaxis, foetal complications. 11. Abnormal PuerperiumPhysiology, clinical features; complications; 2 hours recognition and principles of management, prevention of puerperal sepsis. GYNAECOLOGY 1. Puberty 2 hours 2 hours 2. Malformations of genital tract 4 hours 3. Hormones in gynaecology 2 hours 4. Sex and intersexuality 1 hours 5. Choriocarcinoma 1 hour 6. P I D (Pelvic Inflammatory diseases) 1 hour 7. Benign lesions of the cervix 1 hour 8. Benign lesions of vulva and vagina 1 hour 9. Diseases of broad ligament, fallopian tubes and parametrium 1 hour 10. Precancerous lesions of genital tract 1 hour 11. Screening procedures in gynaecology 1 hour 12. Clinical aspects of menopause 1 hour 13. Low back ache 1 hour 14. Psychosomatic problems in gynaecology 1 hour 9 th TERM OBSTETRICS 1. Breast feeding 1 hours Physiology of lactation, care of breasts; counseling regarding breast feeding, mastitis and breast abscess.
10 2. Care of newborn 1 hours Assessment of maturity, detect asphyxia, principles of resuscitation, common problems. 3. Medical termination of pregnancy 3 hours 1. Legal aspects; indications, methods; complications 2. Management of complications. 4. Family Planning and ContraceptionVarious methods and devices; 8 hours selection of patients: counseling of couples; side effects; failures and complications; Laparoscopic sterilisation, Vasectomy, Tubectomy. 5. Operative Obstetrics 6 hours Indications; technique, and complications for episiotomy, vacuum extraction; low forceps, instrumental evacuation; menstrual regulation. Indications and steps of operation; caesarean section; assisted breech delivery, external cephalic version; cervical cerciage; intra-amniotic instillation, Destructive operations. 6. Post-caesarean pregnancy 1 hour Risk, identification of scar dehiscence. 7. Pharmaco therapeutics in obstetrics Oxytocin, Antihypertensives, Tocolytics, anticonvulsants, maternal drug in take etc. 8. Safe motherhood, obstetrics care and the society. 9. Special topics in Obstetrics High Risk Pregnancy, Immunology in obstetrics, Intrapartum foetal monitoring, Foetal distress, Shock in obstetrics, Blood coagulation disorders in obstetrics. 10. Causes and prevention of Maternal morbidity and maternal mortality in hospital and community settings. 11. Medico legal aspects. 12. Day care in obstetrics. 13. Reproductive and Child Health programme (RCH). 14. Current topics in obstetrics; Women s Health, Gender issues
11 GYNAECOLOGY 1. Carcinoma cervix 2 hours Aetiopathology, clinical features: classification, screening procedures, investigations, diagnosis and principles of management 2. Carcinoma of endometriuin 1 hour 3. Malignant ovarian tumors 2 hours 4. Carcinoma vulva and miscellaneous 1 hour 5. Radiotherapy in gynaecology 1 hour 6. Chemotherapy in gynaecology 1 hour 7. Imaging techniques in gynaecology 1 hour 8. Endoscopy in gynaecology 1 hour 9. Diseases of breast 1 hour 10. Operative gynaecology Dilatition & Currettage in gynaecology and fractional curettage Endometrial biopy and tubal patency test Electric cautersation of cervix, cryosurgery, cervical biopsy Amputation of cervix, trachelorrhaphy Fothergill s operation, vaginal hysterectomy with pelvic floor repair Abdominal hysterectomy,laparotomy for ovarian tumours. Note: The hours indicated are suggestive. Local adjustments may be made. d) Teaching Hours: Theory Teaching of Obstetrics and Gynaecology extends from 4th term to 9 th term, during II and III Phase of M.B.B.S. Total number of teaching hours would be 300 hours, out of which 40 hours are for integrated teaching. Phase Phase II Term 6 th term No. 1 class of classes per week No. of 20 Hours Phase Phase III 74h th term term I class_ 20 Phase Phase III 58d th term No. two of theory classes classes per week of 1 hr No. of 40 Hours
12 * Out of one seminar of 2 hrs 40 which 40 hours one tutorial of 2 hrs 40 are for integrated teaching. Seminars/Tutorials may be used for integrated teaching Integrated Teaching - 40 hours Topics for integrated teaching with the other departments: Sl. No. Topics No.of Hour(s) Department 1. Family Planning 4 Post Partum Center 2. Embryology Integrated foetal growth and development 4 Anatomy 3. Phase III 9h term two theory classes of 1 hr one seminar of 2 hrs one tutorial of 2 hrs Total No. of teaching hours* 300 Physiological changes in pregnancy with maternal adaptation. 4 Physiology 4. Rational use of drugs and Prescribing in pregnancy 4 Pharmacology 5. Nutrition and anaemia in pregnancy 4 Medicine 6. Urological problems in Obst. & Gync. 2 Urology 7. Acute abdomen management & care of the abdomen 4 Surgery 8. Neonatal resuscitation 4 Pediatrics 9. Neonatal problems (Jaundice, Unbelical, Infection, Convulsions) 10. Ultrasound in Obstetrics 2 11. Radiology in Obstetrics 1 2 Pediatrics Radiology / Radiodiagnosis Radiology / Radiodiagnosis 12. Gynaecological malignancies 2 Pathology 13. MCH services: Objectives & Implementation 2 Community Medicine 40 40 40
13 14. Psychiatric problems related to Obst. Gync. I Psychiatry